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BUILDING PERMIT APPLICATION �o Y T«ARD DALE 7-121P77 19-
I HE
9 1HE UNDERSIGNED HEREBY AFPLIES FOR APE RMIT FOF Ir'F WORK HEREIN Irv0ICATFD BUILDER PHONE_
OR AS SHOb!N AND APPROVED IEJ THE ACCOMP4NYING P;.ANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.__
OWNER P6U1 Kil JORADORESS 13 05 3W ASh Dr.
_ HOME F,DDRE._S
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ARCH ITECT'_-�� -- - --
BUILDF_RAGUAR5 -ufit'c_ ADDRESS � ENGINEER
r-t DES.GNER
STRUCTURE _-❑NEWC3 REMODEL _CADDIT_ION K�REPAIR ❑HENEWAL ❑_FINE DAMAGE _ CDEMOLITION
U kSIDENCE ❑COMM ❑EDUCATIONAL GGOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GI,RAGE El STORAGE❑SLAB L-jrENCF..
`❑BOND ❑MOVING []CONDITIONAL USG [:]DESIGN REVIEW ❑COUNCIL A?PR_IVED ❑SIGNS
u LL
OCCUPANCY LAND USE ZONE— BLDG.TYPE FIRE ZONE PLAN CHECK BY. _ HEAT----..
r-:.roof existiI.(.I c�uallines with i60ff fiberglass --
SLG .LQgQ ___F194R LOAD ti€ISaH -----_—_LY4�514BLE� ABS+. itQ�111J&94M;i ____YL.LSZE=�t�C)1-
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 14,.U0
T� THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Pian Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THi
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SP'SCIFI„ATIONS AND IN C)MPL;ANCE WI!H
Sub-total ALL APPLICAPLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIV: COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax I ICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND BEATING.
Total
By
---- ----- . . -- - - -
-� - � ��"^� ii �WT OR A(3EN1
Approved Rr.�• I�i N�
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
— Permit No_^_
Rough-in
Fixture
Final _
_ HEATING
Contractor Y __
Permit Nr.
Gas or Oil
— _—�_ —. ---------- - R o\ugh-i n
Final
CEWER --
- ------- --- Final
DRIVEWAY -�
Final
Storm Drainage__—__
(Rain Drain) Final
Sidewalk_
Curb&Street Final
Approach
BLDG,DEPT.FINAL TEMPORARY CEgTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
«aF4 Zoning Final 1
� G
Aad-ess ����-� .3;rC�� 0S// dwit/permitNo. fJe —
:Jame of Occupant Permit charge
Connection fee ?' cr'�
Paid b
Date connected
Type of Building ES"Dez � _ Inspection fee._
Service Rite �'<�_ Paid by %,T lCi/1« 4— .Date
Contractor .T 11 -//!' /j' Assessment Paid
Size of connection
------------------
PERMIT TO CONNECT
City of Tigard
Permit N? 630 D ATE
PERMIT IS GIVEN TO
000.
OF
TO CONNECT A--
TO THE SYS7,FM OF CITY OF TIGARD
AT
THIS I,,-RMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON.
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PAID $ CITY OF TIGARD
By.
CONNECTION INSPECTED AND APPROVED
Date Superintendent